Abstract
Background
In response to increasing emergency department presentations and wait times in Australia,
multiple strategies and models of care have been implemented with varying results.
One effective strategy has been the implementation of pre-hospital blood collection
by paramedics when they insert an intravenous cannula. This research aims to determine
the efficiency of and barriers to wider implementation of a pre-hospital blood collection
trial in a regional context. In particular, to evaluate the impact of the pre-hospital
blood collection on time to pathology results and error rates, and paramedic opinion.
Methods
This retrospective controlled cohort study was conducted over 12 months from August
2018. Emergency and pathology data were used to determine the haemolysis and error
rates, as well as the time to result availability of pre-hospital blood collection
samples compared to in hospital samples arrived by ambulance. To determine the facilitators
and barriers to wider implementation a survey of 48 paramedics was conducted following
completion of the 12-month trial. The survey was informed by the Theoretical Domains
Framework, a behavior change theory associated with improved uptake when applied.
Findings
Overall 237 samples were collected. There was a 65% (51 min) reduction in time taken for samples to be received at pathology and a 38% (50 min) improvement in time taken for results to return from pathology for patients arrived
by ambulance. There were no labelling errors in the pre-hospital blood collection
group or change in haemolysis rates. The majority (79%) of paramedics who completed
the survey were optimistic about the protocol improving patient outcomes and 89% regarded
the change in practice as acceptable. Three main themes emerged: 1. Training, environmental
challenges and adequate equipment; 2. increased efficiency and improved patient care
and 3. Prerequisites to implementing a new practice. Integration of Quantitative and
Qualitative data resulted in 10 key influencers of behavior that need to be addressed
in any future implementation.
Conclusion and implications for practice
The introduction of pre-hospital phlebotomy reduced the time to blood results availability
by 38% and resulted in fewer labelling errors. Wider implementation is supported by
paramedics, but more training is required.
Keywords
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Article info
Publication history
Published online: September 24, 2020
Accepted:
August 30,
2020
Received in revised form:
August 20,
2020
Received:
July 9,
2020
Identification
Copyright
Crown Copyright © 2020 Published by Elsevier Ltd on behalf of College of Emergency Nursing Australasia. All rights reserved.
